PROJECT ABSTRACT: Tobacco Treatment in the Context of Lung Cancer Screening The activities proposed in this application will assist Dr. Alana Rojewski's development as a clinical researcher with a focus on tobacco treatment in cancer prevention and control, particularly integrating tobacco treatment in the oncology and oncology screening setting. The specific career goals of this application are to: (1) Develop expertise in integrating tobacco treatment in the thoracic oncology and lung cancer screening (LCS) setting; (2) Develop mastery in clinical trials research; (3) Develop expertise in health services research; and (4) to solidify skills in research dissemination. These goals will be accomplished through coursework, seminars, journal clubs, mentored research, manuscript authorship, grant development, and collaboration with other investigators in the rich research environment at Medical University of South Carolina (MUSC). Hollings Cancer Center at MUSC recently established a LCS program, for which the candidate's primary mentor serves as the Co-Director. Screening for lung cancer at earlier, more treatable stages has the potential to reduce mortality from the U.S.'s most deadly cancer. Annual screening with low-dose computed tomography (LDCT) is now recommended for high risk individuals based on age and smoking history. The clinical ramifications of smoking cessation following a LDCT could be profound. To complement the career objectives, the research plan will evaluate a smoking cessation intervention for LCS patients. The primary aim of the study is to conduct a 2-arm pilot randomized clinical trial with patients referred for LCS who smoke (N = 80) to evaluate 7-day point prevalence abstinence rates and determine effect size estimates among participants who receive a standard intervention (brief counseling session at time of LCS) versus a medication and text messaging intervention (MTI; standard intervention + 8 weeks of NRT + gain-framed text messages with medication use reminders). A secondary aim will be to examine 7-day point prevalence abstinence rates and determine effect size estimates at the 3-month follow-up. Further, as exploratory aims, mediators and moderators of smoking cessation outcomes (i.e., nicotine dependence, medication adherence, positive lung finding from the scan [e.g., nodule is present]) and cost-effectiveness of the intervention will be evaluated. The proposed research has numerous strengths including: a) a timely research question, namely how to optimally enhance smoking cessation in current smokers who are receiving LCS; b) gain-framed smoking cessation text messaging specifically developed for LCS patients; and c) potential to easily translate the findings to the growing number of LCS programs across the country. Research on tobacco treatment interventions for LCS patients could reduce the future incidence of cancer and mortality for this high-risk patient population. The research plan will serve as a complement to the candidate's career development plan in furthering training in cancer prevention and control.